吲哚菁绿清除试验在肝移植后肝功能评估中的价值

Applied value of indocyanine green clearance test in assessing liver allograft function in patients using organs from deceased citizens

目的研究吲哚菁绿15min滞留率（retention rate of indoeyanine green at 15 minutes,ICG R15 ） 与肝移植术后肝功能恢复的相关性。方法回顾性分析2015年3月～12月实施的62例肝移植受者的临床资料，分析ICG R15与常规肝功能指标的关系，采用受试者工作特征曲线（ROC曲线）计算Youden指数，获取具有最佳敏感度和特异度组合的ICG R15值作为ICG R15分组的界值，将受者分为高ICG R15组（ICG R15〉9％）和低ICGR15组（ICGR15≤9％）。采用Logistic回归多因素分析研究ICGR15对早期肝功能不全的影响。结果肝移植术后1、3、5、7、14d的ICGR15与相应时间点的血清胆红素总量（r=0．816，P〈0．001）、前白蛋白（r=-0．359，P〈0．001）、白蛋白（r=-0．312，P=0．001）、终末期肝病模型（MELD）评分（r=0．612，P〈0．001）显著相关，并且高ICGR15组的急性排斥反应发生率（x2=4．654，P=0．031）显著高于低ICGR15组。单因素及多因素分析显示ICGR15是早期肝功能不全的独立危险因素。结论肝移植术后ICG R15作为一项简便且有效的独立预后指标，可用来判断肝移植术后受者的预后状况。

Objective To investigate the correlation between the retention rate of indocyanine green at 15 min （ICG R15 ） and short-term prognosis of patients after liver transplantation. Method Sixty-two cases of liver transplantation from March 2015 to December 2015 were analyzed retrospectively. ICG R15 and routine liver function tests after transplantation were analyzed with reference to outcome among liver transplant recipients, Result Among the overall series of patients, the ICG 15 at 1st, 3rd, 7th, 5th, and 14th day after liver transplantation was significantly correlated with total bilirubin （r= 0. 816, P〈0. 001）, pre-albumin （r= - 0. 359, P〈0. 001）, serum albumin （r = -0. 312, P= 0. 001）, and MELD score （r= 0. 612, P〈0. 001） at corresponding time points. A higher incidence of acute rejection was observed in high ICG R15 group. Univariate and multivariate analyses revealed that ICG R15 was an independent factor for early allograft dysfunction. Conclusion Postoperative ICG R15 is an independent predictor of liver allograft function for liver transplant recipients using organs from deceased citizens.